tbuckley/cabot-search huggingface dataset:
Abstract 11945: Improved Outcomes in Severe Primary Graft Dysfunction Following Heart Transplantation With Donation After Circulatory Death Compared to Donation After Brain Death
Authors: Austin Ayer, Lauren Truby, Jacob Schroder, Sarah Casalinova, Cynthia Green, Muath Bishawi, Benjamin Bryner, Chetan B Patel, Adam D Devore
Journal: Circulation (2022)

Introduction: Primary graft dysfunction (PGD), the leading cause of early mortality after heart transplant, is more common following heart donation after circulatory death (DCD) than following donation after brain death (DBD). We conducted a single-center, retrospective cohort study to compare the incidence, severity, and outcomes of patients experiencing PGD after DCD compared to DBD heart transplant. Methods: We reviewed the medical records of all adult heart transplant recipients at our institution between March 2016 and December 2021. Patients undergoing multi-organ transplant were excluded. PGD was diagnosed within 24 hours after transplant according to modified ISHLT criteria and was classified by severity and ventricles involved. Results: A total of 459 qualifying patients underwent heart transplant during the study period, of whom 65 (14%) were DCD recipients and 394 (86%) were DBD recipients. The incidence of PGD in DCD and DBD recipients was 34% and 23%, respectively (p = 0.070). DCD recipients were more likely to experience severe, biventricular PGD than DBD recipients (19% vs. 7.3%, p = 0.004). Among patients with severe PGD, DCD recipients experienced shorter duration of mechanical circulatory support (ECMO, VAD, or balloon pump; mean 6.0 ± 2.5 vs. 12.1 ± 11.3 days, p = 0.039; Figure), shorter post-transplant hospital length of stay (32.4 ± 41.1 vs. 61.9 ± 47.7 days, p = 0.004), and a trend toward improved 60-day survival (100% vs. 80%, p = 0.170) and one-year survival (92% [95% CI: 76%-100%] vs. 69% [53%-84%]). Conclusions: DCD heart transplant recipients were more likely to experience severe, biventricular PGD than DBD recipients. Despite this, short- and medium-term outcomes among patients with severe PGD were improved in DCD compared to DBD recipients. These data suggest different mechanisms of graft dysfunction and recovery following DCD compared to DBD and support the expansion of the heart donor pool with DCD in most potential recipients.
Abstract 13005: Tips and Tricks for Successful Trans-EVAR TAVR: Buddy Up
Authors: Priyanka Ghosh, Amit Shah, Daniel Sporn, Felice Reitknecht, Edo Kaluski
Journal: Circulation (2022)

Trans-catheter aortic valve replacement (TAVR) via tortuous iliofemoral access with prior endovascular aneurysm repair (EVAR) is challenging. 83 year old male with severe aortic stenosis and prior EVAR was evaluated for TAVR with 29 mm Edwards Sapien 3 valve. Right femoral access was planned with ipsilateral protection. CT angiogram showed EVAR with tortuosity, rigidity, and graft protrusion concerning for advancement of equipment. The right iliofemoral system was accessed using a 4F radial sheath, Judkins JR4 catheter, and 0.035” angled glide wire exchanged for Amplatz Superstiff wire. A 30 cm 6F sheath was advanced over the wire followed by additional Superstiff buddy wire. Two Proglides were deployed over two separate wires, without rewiring. To overcome friction on removing second Proglide, predilatation of the arteriotomy should have been performed with a 8-9F sheath. An 8F sheath was advanced over one of two Superstiff wires. A V18 0.018” wire was placed in the ipsilateral protect site, exchanged for a third Superstiff wire to ease insertion of the Edwards sheath. The sheath was advanced followed by successful valve deployment. After removing the delivery system, two pre-deployed Proglides closed the arteriotomy site. Detailed planning enables operators to overcome challenges using the following strategies: 1) avoid unnecessary rewiring of the iliofemoral system by use of a 30 cm 6F sheath, 2) predilate the TAVR arteriotomy with larger sheaths prior to deploying Proglides to avoid limited manipulation space for Proglides and two wires, 3) use buddy wires if TAVR sheath advancement has failed over one wire and consider additional buddy wires from within the TAVR arteriotomy or ipsilateral protection site, and 4) use ipsilateral protection to avoid challenges of crossing over from contralateral iliofemoral. Although trans-EVAR TAVR remains somewhat unpredictable, these strategies may simplify and reduce the inherent failure rate of such procedures.
Abstract 13258: Myosin Light Chain Dephosphorylation by Ppp1r12c Promotes Atrial Hypocontractility in Atrial Fibrillation
Authors: Francisco Gonzalez, srikanth perike, Frederick W Damen, Andrielle Capote, Katherina M Alsina, Benjamin Levin, Arvind Sridhar, Jacob Grand, Jody Martin, Joseph Akar, Chad M Warren, R John Solaro, Dawood Darbar, Craig J Goergen, Beata M Wolska, Xander H Wehrens, Mark McCauley
Journal: Circulation (2022)

Introduction: Atrial fibrillation (AF) is the most common sustained arrhythmia, with an estimated prevalence in the U.S. of 6.1 million . AF increases the risk of a thromboembolic stroke in five-fold. Although atrial hypocontractility contributes to stroke risk in AF, the molecular mechanisms reducing myofilament contractile function in AF remains unknown. We have recently identified protein phosphatase 1 subunit 12c (PPP1R12C) as a key molecule targeting myosin light chain phosphorylation in AF. Objective We hypothesize that the overexpression of PPP1R12C causes hypophosphorylation of atrial myosin light chain 2 (MLC2a), thereby decreasing atrial contractility in AF. Methods and Results Left and right atrial appendage tissues were isolated from AF patients versus sinus rhythm (SR). To evaluate the role of the PP1c-PPP1R12C interaction in MLC2a de-phosphorylation, we utilized Western blots, co-immunoprecipitation, and phosphorylation assays. In patients with AF, PPP1R12C expression was increased 3.5-fold versus SR controls with an 88% reduction in MLC2a phosphorylation. PPP1R12CPP1c binding and PPP1R12C-MLC2a binding were significantly increased in AF. In vitro studies of either pharmacologic (BDP5290) or genetic (T560A) PPP1R12C activation demonstrated increased PPP1R12C binding with both PP1c and MLC2a, and dephosphorylation of MLC2a. Additionally, to evaluate the role of PPP1R12C expression in cardiac function, mice with lentiviral cardiac-specific overexpression of PPP1R12C (Lenti-12C) were evaluated for atrial contractility using echocardiography, versus wild-type and Lenti-controls. Lenti-12C mice demonstrated a 150% increase in left atrium size versus controls, with reduced atrial strain and atrial ejection fraction. Also, programmed electrical stimulation was performed to evaluate AF inducibility in vivo. Pacing-induced AF in Lenti-12C mice was significantly higher than controls. Conclusion The overexpression of PPP1R12C increases PP1c targeting to MLC2a and provokes dephosphorylation, associated with a reduction in atrial contractility and increase in AF inducibility. All these discoveries suggest that PP1 regulation of sarcomere function at MLC2a is a main regulator of atrial contractility in AF.
Abstract 13552: Associations Between Food Security and Social Determinants of Health With Dietary Intakes- A Pilot Study
Authors: Ana F Diallo, Tiara Bolden, Sogand Karimian, Sally Russell, Sameera Talegawkar
Journal: Circulation (2022)

Introduction: Food insecurity remains prevalent in the United States and has disproportionately affected those living in poverty or experiencing financial hardships. Social determinants of health (SODH) influence food security; yet, little is known on which aspects of the built environment influence the most food insecurity and dietary intake, especially among minority groups living in urban food deserts. We conducted a pilot study to examine the association between individuals’ dietary intake, food insecurity and other SODH measures among individuals residing in an urban food desert. Methods: We recruited 45 adults, residing in the targeted study area. Following consent, participants completed surveys to measure sociodemographic and health status, dietary intake, social determinants of health (food insecurity, perceived neighborhood safety, healthy food environment, perceived discrimination). All demographic and survey data were examined graphically and summarized descriptively. Analysis of variance was used to examine associations between dietary data and SODH measures. Results: Overall, ~78% of the participants were African American, female (80%), 53 years old on average. More than 50% lived in a household with a yearly income below $12,000. Education level and neighborhood safety were the major SODH influencing dietary intake. Majority of participants were food insecure and 54% reported not feeling safe in their neighborhood. The effect of food insecurity was significant on the average intake of processed meat (F = 4.72, p = .036), fast food (F= 4.384, p= .042) and whole grains (F= 4.573, p= .038). The effect of education level on average intake of processed meat was significant, F = 3.59, p=.02. Lastly, neighborhood safety significantly influenced the average intake of processed meat (F= 3.593, p= 0.022). Conclusions: Findings from this pilot study confirm the importance of examining neighborhood contextual factors such as SODH in relation to food insecurity and diet. A better understanding of the relationships between dietary intake and SODH have important implications for clinical practice, behavioral interventions and policies aiming to decrease diet-related health disparities.
Abstract 14845: Evaluation of Heart Failure With Preserved Ejection Fraction in Patients With Symptomatic Atrial Fibrillation by Invasive Assessment of Left Atrial Compliance
Authors: Jonathan P Ariyaratnam, Ricardo Mishima, Olivia P McNamee, Kadhim I Kadhim, Mehrdad Emami, Dennis Lau, Celine Gallagher, Adrian Elliott, Prashanthan Sanders
Journal: Circulation (2022)

Background: Atrial fibrillation (AF) and HFpEF are both associated with left atrial (LA) cardiomyopathy. We hypothesise that HFpEF is common in patients with symptomatic AF due to the presence of LA cardiomyopathy involving reduced LA compliance (LAC). Methods: Consecutive patients with AF and preserved left ventricular (LV) function were prospectively recruited. Gold-standard diagnosis of HFpEF was undertaken by invasive assessment of LA pressure; participants had ‘AF-HFpEF’ if baseline mean LA pressure (mLAP) was &gt;15mmHg and ‘early AF-HFpEF’ if mLAP exceeded 15mmHg only after 500mls fluid challenge. LAC was assessed by monitoring atrial pressures and LA size during infusion of 15mL/kg normal saline over 8 minutes. Transmural LAC was calculated as ΔLA diameter/Δ(LA pressure - RA pressure). All participants were also studied with resting and exercise echocardiography, electrophysiology (EP) study, cardiopulmonary exercise testing and AF Symptom Severity questionnaires. Results: Of 105 participants, 49 (46.7%) had AF-HFpEF, 26 (24.8%) had early AF-HFpEF and 30 (28.6%) had no HFpEF. AF-HFpEF was associated with increased BMI (p=0.03) and higher prevalence of hypertension (p&lt;0.01). AF-HFpEF was associated with lower transmural LAC compared to those with no HFpEF (1.36±0.45 vs 3.32±0.46, p=0.01). As shown in the table, participants with AF-HFpEF also displayed reduced LA mechanical function at rest and during exercise, LA electrical remodelling, reduced cardiorespiratory fitness and increased AF symptom burden. Conclusions: HFpEF is common in patients with symptomatic AF and is associated with increased BMI and hypertension. AF-HFpEF is characterized by a global LA cardiomyopathy involving reduced LAC, reduced LA mechanical function and LA electrical remodelling. Diagnosis of HFpEF in patients with AF may identify those with increased symptom burden, reduced exercise capacity and increased risk of stroke. (Trial registration: ACTRN12620000639921)
Abstract 13047: Are Clinicians Using All Available Strategies to Achieve Guideline-Recommended Lipid Lowering?
Authors: Ann M Navar, Anand Gupta, Kristin K Gillard, Marc Israel, Eric D Peterson
Journal: Circulation (2022)

Introduction: Despite their safety, efficacy, and low-cost, statins are under-utilized in both primary and secondary prevention populations. Multiple strategies are available to facilitate lipid lowering in those who report statin intolerance including using alternate statins, low-intensity or alternate-day statin dose schedules, or using non-statin lipid lowering therapies. However, the degree to which these alternative strategies are tried in community practice is unknown. Methods: We evaluated prior statin use among n=731,895 persons who met guideline recommendations for statin therapy between 2017-2018 in Cerner RealWorldData, an electronic health record (EHR)-based dataset from 94 health systems. Medication data available included all prescriptions generated from the EHR and self-reported medications recorded in the EHR (median of 4 years of medication data for each subject). Results: Among 731,895 individuals who met guideline recommendations for statin therapy, 278,434 (38.0%) were not on a statin. Of those not on a statin, only 20.1% (n=55,875) had any evidence of prior statin therapy, and 12.3% had documentation of a statin allergy. Among prior statin users,most had only tried one (68.0%) or two (23.5%) statins before stopping all together. Only 1.3% of former statin users had been prescribed a statin at less than daily frequency, while 22.6% had been prescribed a low-intensity statin at some point in the past. Utilization of non-statin lipid lowering therapy was also rare: Among those not on a statin, only 2.6% were on ezetimibe, 4.4% were taking a fibrate, 1.5% a bile acid sequestrant, 1.6% niacin, and 0.3% were taking on a PCSK9 inhibitor. Conclusion: Across 94 health systems, almost 40% of persons recommended for statin therapy for primary or secondary prevention were not on a statin, the vast majority of which had no evidence of prior statin utilization. Of those who had tried a statin in the past but discontinued therapy, very few appeared to have attempted a re-challenge with a different statin, tried alternative dosing strategies to improve tolerability, or initiated non-statin lipid lowering therapy.
Abstract 13432: Association Between a Deep Learning Enabled Algorithm Using ECG Signals to Predict Coronary Calcium and Survival
Authors: Jose R Medina-Inojosa, Betsy Medina-Inojosa, Michal Shelly, Zachi Attia, Mohammad Ali Sheffeh, Abraham Baez Suarez, Paul Friedman, Rickey Carter, Francisco Lopez-Jimenez
Journal: Circulation (2022)

Background: We developed a deep learning algorithm to predict elevated coronary artery calcium (CAC) score from 12-lead electrocardiograms (CAC- ECG). We tested the hypothesis that this CAC-ECG algorithm will independently predict long-term survival. Methods: We leveraged a historical cohort of 43,210 consecutive patients who from the years 1997-2020 underwent clinically indicated ECG-gated unenhanced chest computed tomography (CT) to identify and quantify CAC and had an ECG within 1 year of the CT. Data on cardiovascular risk (CV) factors, and to calculate the Pooled Cohort Equation (PCE) for ASCVD was collected as part of preventive cardiology or general medical evaluations. We used the oldest CAC in record and excluded those taking statins at the time of the CAC. The algorithm was trained in 60% of the cohort, and the association between CAC-ECG and survival was evaluated with multivariate cox proportional hazard models in 40% of the remaining observations. Results: Of the 17,284 evaluated patients, mean ± SD age 55.9 ± 9.9, 33% female, 3,714 (21%) had elevated CAC ≥ 300. During an average of 15±5.9 years follow-up, 848 (5%) patients died. The algorithm’s area under the receiving operating characteristics curve (ROC), sensitivity, specificity, and accuracy to detect a CAC ≥ 300 were 0.83, 0.90%, 0.56%, 0.60%. Those with elevated CAC had a nearly two-fold risk of death, a value similar to those deemed positive by the ECG-CAC algorithm ( Figure A ). Risk of death increased with CAC-ECG probability quartiles ( Figure A ). The CAC-ECG algorithm enhanced predicted capabilities of the PCE across all ASCVD risk subgroups ( Figure B ), as well as in those with no CAC and elevated CAC ( Figure C ), all p for trend &lt;0.001. Conclusions: A deep learning-enabled CAC-ECG algorithm was independently associated with long-term survival and enhanced current risk prediction paradigms. The CAC-ECG algorithm could help identify individuals at risk in primary prevention of CV disease.
Abstract 13289: Risk of QT Interval Prolongation Associated With Dofetilide and Sotalol in Patients With Heart Failure With Preserved Ejection Fraction
Authors: Chien-Yu Huang, Brian R Overholser, Kevin M Sowinski, Heather A Jaynes, Richard KOVACS, James E Tisdale
Journal: Circulation (2022)

Introduction: Heart failure (HF) with reduced ejection fraction (HFrEF) is a risk factor for drug-induced QT interval prolongation. It is unknown if HF with preserved ejection fraction (HFpEF) also increases the risk. Dofetilide (D) and sotalol (S) are potent QT interval-prolonging agents that are commonly used in patients with HFpEF, in whom atrial fibrillation is a common comorbidity. Hypothesis: The risk of QTc prolongation associated with D or S (D/S) is increased in patients with HFpEF. Methods: The data source was electronic health records from the Indiana Network for Patient Care (February 2010 to May 2021). After removing patients with overlapping diagnoses of HFpEF and HFrEF, no diagnosis code, absence of QT interval records, and no validated record of using D/S, we identified patients taking D/S among three groups: HFrEF (n=138), HFpEF (n=109), and no HF (n=729). Cochran-Mantel-Haenszel statistics were used to compare baseline characteristics. QT interval prolongation was defined as heart rate-corrected QT (QTc) &gt; 500 ms during D/S therapy. Unadjusted odds ratios (OR) of QT interval prolongation were determined by univariate analysis, and adjusted ORs were determined by generalized estimating equations (GEE) with logit link to account for an individual cluster with different times of hospitalization and covariates. Results: QTc prolongation associated with D/S occurred in 51.2% of patients with HFpEF, 70.1% of patients with HFrEF, and 29.4% of patients with no HF. After adjusting for age, sex, race, serum potassium and magnesium concentrations, kidney function, concomitant drug therapy, and comorbid conditions, the adjusted odds of QTc prolongation were significantly higher in patients with HFpEF, as well as in those with HFrEF, compared to those with no evidence of HF (Table). Conclusions: The odds of QT interval prolongation among inpatients receiving D/S were increased in patients with HFpEF and HFrEF compared to those who did not have HF.
Abstract 14384: A Decade Trend, Sex, Racial and Economic Disparities in Hospitalization for Premature Acute Myocardial Infarction Among Patients With Obesity and Morbid Obesity: A Decade Trend From the National Inpatient Sample
Authors: IRIAGBONSE R ASEMOTA, Hafeez Shaka, Bharosa Sharma, Emmanuel Akuna, Muhammad Usman Almani, Muhammad Usman, Muhammad Khawar Sana, Mahir Yilmaz, Sean DeAngelo, Hasan Hammo
Journal: Circulation (2022)

Introduction: Epidemiological evidence suggests that obesity is associated with Acute myocardial infarction (AMI). Studies on the incidence and outcomes of patients with premature AMI who are obese are limited with attention to disparities are scarce. Hypothesis: Obesity and Morbid Obesity is associated with increasing premature AMI Methods: This was a trend study of the National Inpatient database from 2010 to 2019. We searched for AMI as primary reason for hospitalization with obesity or morbid obesity as a comorbidity using the ICD codes. We estimated trends, inpatient mortality, mean length of hospital stays (LOS) and mean total hospital charges (THC) over the period. We performed a stratified analysis in categories: sex (male and female), race (Caucasians, Blacks, Hispanics), and median household income for patient's zip code (low-income quartile [LIQ] vs high-income quartile [HIQ]) to assess disparities in outcomes. Multivariable regression analysis adjusted for age and sex was used to obtain trend statistics on outcomes. Results: There was a total of 173,106 hospitalizations for obesity with early AMI with the proportion of females (63.7%). There was an increase in early MI by 60.9% among obese patients, with mean in-hospital mortality of 1.3%. Female obese patients had a 33% increase in inpatient mortality with premature AMI, with the highest increase among black women compared to white women (78.7% vs. 35.0%). Hospitalization for adult premature AMI in patients with morbid obesity was 64,926 with proportion of female 66.1% from 2010 to 2019. The incidence of hospitalization for premature AMI among morbidly obese patients increased by 120% from 2010 to 2019. The average mortality from 2010 to 2019 among morbidly obese patient with premature AMI was 2.0% in the decade studied. There was a trend toward decreased mortality over the years; however, on subgroup analysis, the decrease in mortality was significant among whites but not among blacks, LIQ, or HIQ in early MI with morbid obesity. Conclusions: Our study shows a significant increase in hospitalization for premature AMI in obese and morbidly obese patients. The female obese patient has higher inpatient mortality with highest among blacks compared to whites.
Abstract 13804: Effect of Cardiac Catheterization Timing on In-Hospital Outcomes for Patients Presenting With Non ST Elevation Myocardial Infarction on the Weekend
Authors: Paola A Lecompte Osorio, Michael Dangl, michael Albosta, Rafael Hernandez, Carlos Vergara-Sanchez, Karla Inestroza, Ian Ergui, Rosario Colombo
Journal: Circulation (2022)

Introduction: Patients admitted to hospital for non-ST elevation myocardial infarction (NSTEMI) on a weekend have higher rates of mortality. Delayed catheterization and revascularization have been hypothesized as a potential etiology. Few studies have evaluated the timing of catheterization and outcomes for NSTEMIs occurring on the weekend. Hypothesis: Delayed catheterization in patients with NSTEMI on a weekend is associated with higher mortality. Methods: The National Inpatient Sample Database was queried from 2016-2019. Baseline characteristics and in-hospital outcomes of NSTEMI were compared in patients who presented on the weekend based on timing of diagnostic cardiac catheterization. Multivariate logistic-regression was performed for the effect of cardiac catheterization timing on mortality. A p-value was considered significant when &lt;0.001. Results: We found a total of 275,545 hospital admissions occurring on the weekend for patients with a primary diagnosis of NSTEMI. Patients were classified in 3 categories. Early catheterization 98,005 (36%) defined as catheterization on or before hospital day 1, delayed catheterization 102,850 (37%) defined as catheterization on or after hospital day 2, and patients that were not catheterized 74,690 (27%). Among patients who received catheterization, mortality was significantly higher in patients who received delayed catheterization 2.9% vs 1.3%, p&lt;0.001. Patients who underwent delayed catheterization had higher odds of mortality compared to early catheterization (adjOR 1.83 95% CI [1.69-1.98]). Highest mortality presented in patients who did not receive catheterization 10.4%, p&lt;0.001 (adjOR 3.39 [3.23-3.56]). Among patients who died without receiving catheterization (n=7,770), 51.6% died within 2 days of hospitalization. Conclusion: For patients presenting with a NSTEMI on the weekend, delayed catheterization is associated with higher mortality.